NPIMap

Organization Active NPI

Trinity Regional Medical Center

Doing business as Unitypoint Clinic - Express in Fort Dodge

  • Rural Health Clinic/Center
  • Fort Dodge, IA
National Provider Identifier
1629651906
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TRINITY REGIONAL MEDICAL CENTER
Doing business as
Unitypoint Clinic - Express in Fort Dodge
Practice address
2728 2ND Ave S
Fort Dodge, IA 50501-6710
Phone
(515) 574-6170
Fax
(515) 574-6171
NPI assigned
May 4, 2021
Last updated
Nov 19, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TRINITY REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Leah M Glasgo
Title
Market President
Phone
(515) 573-3101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2728 2ND Ave S
Fort Dodge, IA 50501-6710

Mailing address

802 Kenyon Rd
Fort Dodge, IA 50501-5740
Phone (515) 574-6565

Other names 1

  • UNITYPOINT CLINIC - EXPRESS IN FORT DODGE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210609003001 IA Part A Provider - Rural Health Clinic 7315858529 Practice locations: Fort Dodge, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629651906. Details of each certification follow.

Rural health clinic certification: CCN 168658

Legal name
TRINITY REGIONAL MEDICAL CENTER
Doing business as
UNITYPOINT CLINIC - EXPRESS IN FORT DODGE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 20, 2021
Last certification
Dec 20, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 8, 1973 in IA
Enrollment address
2728 2ND Ave S
Fort Dodge, IA 50501-6710
Related CCNs
160016

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2218024Unitypoint Clinic - Express in Fort Dodge2728 2ND Avenue South, Fort Dodge, IA 50501Certificate of waiverMar 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Beth Brady Arnp21 organizations share this tax ID, including this one
Part of
Beth Brady Arnp

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Ownership & related parties

All disclosed owners & managing parties 20

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lincoln R Wallace Individual Corporate Officer Jan 1, 2018
Corporate Director Jan 1, 2015
Charles Clayton Individual Corporate Director Jan 1, 2022
Trinity Health Systems, Inc Organization, Fort Dodge, IA Corporation, Non-profit Operational/Managerial Control Nov 4, 1983
Angela M Tracy Individual W-2 Managing EmployeeClinic Administrator Feb 8, 2021
Operational/Managerial ControlClinic Administrator Feb 8, 2021
Clay Holderman Individual OtherChain Home Office Administrator Feb 8, 2021
Kelli Wallace Individual Contracted Managing EmployeeMedical Director Dec 20, 2021
Operational/Managerial ControlMedical Director Dec 20, 2021
Amanda M Lyon Individual Contracted Managing EmployeeDirector of Clinic Operations Aug 29, 2021
Operational/Managerial ControlDirector of Clinic Operations Aug 29, 2021
Neven Conrad Individual Corporate Officer Jan 1, 2020
Corporate Director Jan 1, 2017
Sarah Marsh Individual Contracted Managing EmployeeVice President - Finance Dec 9, 2019
Corporate OfficerVice President - Finance Dec 9, 2019
Operational/Managerial ControlVice President - Finance Dec 9, 2019
Christine R Frideres Individual Corporate Officer Jan 1, 2023
Corporate Director Jan 1, 2016
Debra D Johnson Individual Corporate Director Jan 1, 2013
Michael J Frischmeyer Individual Corporate Director Jan 1, 2014
Leah M Glasgo Individual Contracted Managing EmployeePresident & Ceo Jan 28, 2019
Corporate OfficerPresident & Ceo Jan 28, 2019
Corporate DirectorPresident & Ceo Jan 28, 2019
Operational/Managerial ControlPresident & Ceo Jan 28, 2019
Iowa Health System Organization, West Des Moines, IA Corporation, Non-profit Operational/Managerial Control Dec 31, 1998
Michael J Willerth Individual Corporate Director Jan 1, 2013
Michael Lee Individual Contracted Managing EmployeeRegional VP/Medical Director Jan 1, 2022
Corporate Director Oct 28, 2021
Operational/Managerial ControlRegional VP/Medical Director Jan 1, 2022
Jennifer Crimmins Individual Contracted Managing EmployeeRegional VP/Clinic Operations Feb 1, 2019
Operational/Managerial ControlRegional VP/Clinic Operations Feb 1, 2019
Jill Nelson Individual Corporate Director Jan 1, 2022
Keith Kolacia Individual Corporate Director Jan 1, 2022
Kari L Jones Individual W-2 Managing EmployeeCne Jul 6, 2020
Operational/Managerial ControlCne Jul 6, 2020

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 79

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 79

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1629651906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 KENYON RD",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505015740",
            "telephone_number": "515-574-6565",
            "fax_number": "515-574-6504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2728 2ND AVE S",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505016710",
            "telephone_number": "515-574-6170",
            "fax_number": "515-574-6171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRINITY REGIONAL MEDICAL CENTER",
        "enumeration_date": "2021-05-04",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "GLASGO",
        "authorized_official_first_name": "LEAH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MARKET PRESIDENT",
        "authorized_official_telephone_number": "515-573-3101"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UNITYPOINT CLINIC - EXPRESS IN FORT DODGE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UNITYPOINT CLINIC - EXPRESS IN FORT DODGE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Dodge, IA

Sources for this page

Verify at the official NPI Registry.